Der Unfallchirurg
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Since the introduction of biologicals and small molecules for the treatment of inflammatory rheumatic diseases, these patients are more active and therefore sustain more accidents. The hands and feet are most affected by inflammatory rheumatic diseases, especially rheumatoid arthritis, and are also very exposed to injuries. Therefore, rheumatoid patients have a high coincidence of injuries and rheumatic destruction of the hands and feet. ⋯ This is necessary to avoid fundamental errors in the treatment of fractures and optimally used anesthesia for the benefit of the patient. The close cooperation between trauma surgeons and orthopedic rheumatologists is urgently recommended in the treatment of these injuries. Whenever possible, the treatment should be carried out conservatively because surgical treatment has a higher risk compared to the normal population due to the immunosuppressive treatment.
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Inflammatory rheumatic diseases in childhood and adolescence are a special challenge in the treatment of acute trauma. The pharmaceutical treatment strategies for children and adolescents have been modified. ⋯ An interdisciplinary concept can help to avoid disadvantages in the treatment of the underlying disease. Due to the special dysplastic anatomy and tissue alterations, trauma in these patients is a particular challenge.
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This article reports a case of medial dislocation of the talus as a rare injury caused by a fall from a low height. Treatment recommendations given in the literature for this rare injury are heterogeneous but closed reduction is predominant. ⋯ The known complications include posttraumatic arthritis and necrosis of the talus. A posttraumatic lesion of the tibial nerve has not been reported, which is why a treatment recommendation is illustrated and discussed based on this case report.
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With a prevalence of approximately 0.4%, distal femoral fractures are a rare entity. Nevertheless, due to the high mortality rates, which are comparable to proximal femoral fractures, these fractures are highly important. The clinical symptoms are often quite striking. ⋯ The use of external fixation of the complete knee joint in the sense of damage control surgery, is useful. For definitive treatment retrograde intramedullary nailing and locking plates with angle stable screws are the main options. Modern angle stable and anatomically preformed implants enable surgical treatment using minimally invasive approaches to protect the soft tissues, with a better overall outcome.